1780639278 NPI number — MS. JULIA B JOHNSTON MSW, LCSW, BCD

Table of content: MS. JULIA B JOHNSTON MSW, LCSW, BCD (NPI 1780639278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780639278 NPI number — MS. JULIA B JOHNSTON MSW, LCSW, BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
JULIA
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, BCD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSTON
Provider Other First Name:
JULIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW, BCD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780639278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1203 BAHAMA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAHAMA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27503-9017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-286-1920
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1203 BAHAMA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAHAMA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27503-9017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-286-1920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C000492 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6002106 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60233 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 277696000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 131084 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7670351 . This is a "AETNA HEALTH INSURANCE" identifier . This identifiers is of the category "OTHER".




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